Remedy for cardiomyopathy

ABSTRACT

The present invention provides a cardiomyopathy therapeutic agent that contains hepatocyte growth factor (HGF) and gelatin hydrogel, and gradually releases HGF, which is useful in treating cardiomyopathy.

TECHNICAL FIELD

The present invention relates to cardiomyopathy therapeutic agent thatcontains hepatocyte growth factor (HGF) and gelatin hydrogel, andgradually releases HGF.

BACKGROUND ART

Hepatocyte growth factor (HGF) is a growth factor that was partiallypurified from rat blood during liver regeneration as a growth factor formature rat primary cultured hepatocytes by Nakamura et al. in 1984, andits gene has been cloned (Biochem. Biophys. Res. Commun., 122, 1450(1984); Proc. Natl. Acad. Sci. USA, 83, 6489 (1986); FEBS Letters, 22,311 (1987); Nature, 342, 440 (1989); Proc. Natl. Acad. Sci. USA, 87,3200 (1990)).

As a result of subsequent research, HGF was determined to not only actto promote growth by functioning to repair and regenerate liver damageas a liver regeneration factor in vitro, but also have extremely diverseproperties including promoting migration with respect to various targetcells, inducing morphogenesis and inhibiting apoptosis, thereby play animportant role as a regeneration and maintenance factor of organs andtissues, and with respect to the heart, have cardiovascular protectiveaction such as promotion of vascularization, prevention of reperfusioninjury and inhibition of fibrosis, thereby play an important role in thetreatment or prevention of ischemic diseases and artery diseases (Symp.Soc. Exp. Biol., 47, Cell Behavior, 227-234 (1993); Proc. Natl. Acad.Sci. USA, 90, 1937-1941 (1993); Circulation, 97, 381-390 (1998)).

In this manner, HGF has various functions including vascularizationaction. Consequently, various attempts have been made to use HGF as apharmaceutical.

However, since the half-life of HGF in the blood is short at several toten minutes, it is difficult to maintain its concentration in the blood.In addition, there was also the problem of inadequate transmigration ofHGF to an affected area. Thus, if HGF is merely administered as anaqueous solution, it ends up rapidly diffusing from the administrationsite and subsequently being excreted, thereby making it difficult toobtain adequate effects of the physiological activity of HGF.

A treatment method for cardiomyopathy that uses HGF gene has also beendeveloped. This treatment method consists of administering the genemainly into muscle, causing the gene to be incorporated in muscle cells,and causing the expression product of the inserted gene in the form ofprotein to be secreted from the cells containing the gene. This methodis characterized by gradual release using cells, or in other words,causing cells to gradually release a vascularization induction factor.However, this method has the shortcomings of the gene expressionefficiency of HGF being low, and being unable to control the level ortiming of gene expression. In addition, there is also the problem of theexpression of unknown effects resulting from gene insertion still nothaving been resolved.

In brief, the most important factor in terms of solving theaforementioned problems is the gradual release of vascularizationinduction factor. The reason for attempting to secrete a cell growthfactor from cells using a gene and obtain the effects of its gradualrelease is that, in the case of administering a vascularizationinduction factor in the form of an aqueous solution, expression of theaction of the vascularization induction factor is not observed at all,and the vascularization induction factor itself is unable to begradually released.

If it were possible to gradually release a cell growth factor as in thepresent invention however, it would be meaningless to select a methodthat uses a gene, and the aforementioned problems would be able to besolved.

The only way to increase efficacy in vivo is to immerse HGF in a polymercarrier to enable gradual release of HGF over a long period of time. Inrecent years, several tests have shown that, in the case of combiningthe use of various carrier matrices, several growth factors such asbasic fibroblast growth factor, bone morphogenic protein andtransforming growth factor demonstrate predicted physiological activityin vivo (Downs, E. C. et al., 1992; Miyamoto, et al., 1992; Gombotx, W.R. et al., 1993). However, there are no reports whatsoever regarding thegradual release of HGF in vivo. There have only been several researchresults which have shown that predicted physiological activity can beinduced when a physiologically excess dose of HGF solution is injected.

In addition, HGF is known to inhibit fibrosis of heart muscle by meansof blocking angiotensin II in laboratory animals (Taniyama, T. et al.,Circulation (2000) 102: 246-252). It is also conversely known thatimpairment of HGF production in heart failure patients can be eliminatedby administration of angiotensin convertase inhibitor (Yasuda, S. etal., Hypertension (1993) 33:1374-1378).

On the other hand, although dilated cardiomyopathy is a refractorydisease characterized by fibrosis of heart muscle and its accompanyingdegeneration (hypertrophy, atrophy) of heart muscle cells, an effectivetreatment method has yet to be found.

As a result of conducting extensive studies on therapeutic agents fordilated cardiomyopathy, the inventors of the present invention foundthat treatment using an HGF gradual release preparation that uses agelatin hydrogel developed by Tabata et al. demonstrates remarkabletherapeutic effects against heart disease in dilated cardiomyopathymodel rats, thereby leading to completion of the present invention.

DISCLOSURE OF THE INVENTION

The object of the present invention is to provide a cardiomyopathytherapeutic agent that contains HGF and gelatin hydrogel, and graduallyreleases HGF.

A gelatin used in the present invention differs from commerciallyavailable gelatin and is a gelatin that has the following physicalproperties:

-   -   (1)an acidic gelatin obtained from collagen by alkaline        hydrolysis treatment;    -   (2)molecular weight under non-reducing conditions of SDS-PAGE of        about 100,000 to about 200,000 daltons; and,    -   (3)the zeta potential in aqueous solution of about −15 to about        −20 mV.

Although examples of commercially available gelatins include the type Agelatin manufactured by Sigma and the gelatin manufactured by Wako PureChemical Industries, the zeta potential in aqueous solution differs inthe manner shown below.

Sigma Type A Gelatin: Roughly 0 to roughly 5 mV

Wako Gelatin: Roughly −5 to roughly −2 mV

The zeta potential is an indicator that represents the degree ofelectrostatic charge of a substance (gelatin), and is considered to besuitable as an indicator of a gelatin that forms an electrostaticcomplex with HGF in the present invention.

A gelatin of the present invention is obtained by alkaline hydrolysisfrom a part such as the skin or tendon of various animal species such ascows, from collagen, or from a substance used as collagen. Preferably,it is an acidic gelatin prepared by alkaline treatment of type Icollagen originating in bovine bone, and can also be acquired having asample isoelectric point (IEP) of 5.0 from Nitta Gelatin. Furthermore,although basic gelatin prepared by acid treatment can also be similarlyacquired from Nitta Gelatin having an IEP of 9.0, the zeta potential isconsiderably different as indicated below.

Acidic gelatin (Nitta Gelatin sample IEP 5.0): Roughly −15 to roughly−20 mV

Basic gelatin (Nitta Gelatin sample IEP 9.0): Roughly +12 to roughly +15mV

A gelatin hydrogel used in the present invention refers to a hydrogelobtained by using the aforementioned gelatin and condensing with variouschemical crosslinking agents. Examples of chemical crosslinking agentsthat can be used include glutaraldehyde, EDC and other water-solublecarbodiimides, propylene oxide, diepoxy compounds and condensationagents. An example of a chemical crosslinking agent that is usedpreferably is glutaraldehyde.

In addition, the gelatin can also be crosslinked by heat treatment orultraviolet irradiation.

There are no particular limitations on the form of the gelatin hydrogel,and examples include cylinders, square columns, sheets, disks, spheresand particles. Gelatin hydrogels in the form of cylinders, squarecolumns, sheets and disks are frequently used as implants, while spheresand particles can also be administered by injection.

Gelatin hydrogels in the form of cylinders, square columns, sheets anddisks can be prepared by adding a crosslinking agent aqueous solution toa gelatin aqueous solution or adding gelatin to a crosslinking agentaqueous solution, followed by pouring into a mold of a desired shape andallowing the crosslinking reaction to proceed. In addition, a moldedgelatin gel may be added directly or after drying to a crosslinkingagent aqueous solution. The crosslinking reaction is stopped bycontacting with a low molecular weight substance having an amino groupsuch as ethanol amine or glycine, or by adding an aqueous solutionhaving a pH of 2.5 or lower. The resulting gelatin hydrogel is used toprepare a preparation after washing with distilled water, ethanol,2-propanol or acetone and so forth.

A gelatin hydrogel in the form of spheres or particles can be preparedby, for example, attaching an immobilized stirring motor (for example,the 3-1 motor, EYELA mini D.C. stirrer, manufactured by ShintoScientific) and Teflon (registered trademark) propeller to athree-mouth, round-bottom flask, placing the flask and immobilizedapparatus in a gelatin solution, adding an oil such as olive oil,stirring at a speed of about 200 to 600 rpm to form a W/O emulsion andadding a crosslinking agent aqueous solution thereto, or dropping theproduct of pre-emulsifying a gelatin aqueous solution in olive oil (forexample, using the Advantec 21 vortex mixer, homogenizer or polytronPT10-35) into olive oil to prepare a fine particulate W/O emulsion,followed by the addition of a crosslinking agent aqueous solution andallowing the crosslinking reaction to proceed. After then recovering thegelatin hydrogel by centrifugal separation, it is washed with ethylacetate and so forth followed by immersing in 2-propanol or ethanol tostop the crosslinking reaction. The resulting gelatin hydrogen particlesare used to prepare a preparation after sequentially washing with2-propanol, Tween 80-containing distilled water and distilled water.

In the case the gelatin hydrogel particles aggregate, the addition of,for example, a surfactant or ultrasonic treatment (preferably for nomore than about 1 minute while cooling) may be carried out.

Furthermore, a fine particulate gelatin hydrogel having a particle sizeof 20 μm or less can be obtained by pre-emulsification.

The mean particle size of the resulting gelatin hydrogel particles is 1to 1000 μm, and these particles should be used after sizing to therequired size according to the purpose of use.

The following provides an example of another method of preparing agelatin hydrogel in the form of spheres or particles.

After placing olive oil in the same apparatus as used in the previousexample, stirring at a speed of about 200 to 600 rpm, dropping in agelatin aqueous solution to prepare a W/O emulsion and cooling, ethylacetate and so forth is added and stirred followed by recovering thegelatin particles by centrifugal separation. After additionally washingthe recovered gelatin particles with acetone and ethyl acetate, and thenwith 2-propanol and ethanol, etc., the particles are allowed to dry. Thedry gelatin particles are then suspended in a crosslinking agent aqueoussolution containing 0.1% Tween 80, the crosslinking reaction is allowedto proceed while stirring gently, and the particles are washed with 100mM glycine aqueous solution containing 0.1% Tween 80 or 0.004 N HClcontaining 0.1% Tween 80 depending on the crosslinking agent usedfollowed by stopping the crosslinking reaction to prepare gelatinhydrogel particles. The mean particle size of the gelatin hydrogelparticles obtained with this method is similar to that in the case ofthe aforementioned method.

The mechanism of this gradual release is based on vascularizationinduction factor being physically immobilized on gelatin within thehydrogel. In this state, the factor is not released from the hydrogel.If the gelatin molecules become soluble in water as a result of thehydrogel being decomposed, the immobilized vascularization inductionfactor is released accompanying that decomposition. Namely, the gradualrelease properties of the vascularization induction factor can becontrolled by the decomposition of the hydrogel. The ease ofdecomposition of the hydrogel can be changed according to the degree ofcrosslinking during preparation of the hydrogel.

There are no particular limitations on the conditions of thecrosslinking reaction, and it can be carried out, for example, at 0 to40° C. for 1 to 48 hours.

A gelatin hydrogel of the present invention is such that its moisturecontent clearly has a considerable effect on the gradual releaseproperties of the vascularization induction factor, and an example of amoisture content that demonstrates preferable gradual release effects isabout 80 to 99 w/w %, while a more preferable moisture content is about95 to 98 w/w %. Moisture content can be used as a measurable indicatorof the degree of crosslinking. A large moisture content indicates a lowdegree of crosslinking as well as greater susceptibility todecomposition. In other words, the value of this moisture contentaffects the gradual release properties of the vascularization inductionfactor.

A gelatin hydrogel of the present invention can be used after suitablycutting to an appropriate size and shape, freeze-drying and sterilizing.Freeze-drying can be carried out by, for example, placing the gelatinhydrogel in distilled water, freezing for 30 minutes or more in liquidnitrogen or for 1 hour or more at −80° C., and then drying for 1 to 3days in a freeze-dryer.

Although the concentrations of gelatin and crosslinking agent whenpreparing a gelatin hydrogel should be suitably selected according tothe desired moisture content, an example of the gelatin concentration is1 to 20 w/w %, while an example of the crosslinking agent concentrationis 0.01 to 1 w/w %.

The HGF used in the present invention is a known substance, and thatprepared by various methods can be used provided it has been purified toa degree that allows it to be used as a pharmaceutical. In addition, acommercially available product (such as Toyobo Code No. HGF-101) mayalso be used. An example of a method for producing HGF consists ofculturing primary cultured cells or established cells that produce HGF,separating from the culture supernatant and so forth, and purifying toobtain said HGF. Alternatively, a gene that encodes HGF can beincorporated in a suitable vector using genetic engineering techniquesfollowed by transformation of a suitable host by inserting in said host,and then obtaining the target recombinant HGF from the culturesupernatant of the transformants (refer to, for example, Nature, 342,440 (1989); Japanese Unexamined Patent Publication No. JP1993-111382;Biochem. Biophys. Res. Commun. 163, 967 (1989)). There are no particularlimitations on the aforementioned host cells, and various host cellsconventionally used in genetic engineering techniques can be used,examples of which include E. coli, yeast and animal cells. The HGFobtained in this manner may have one or multiple amino acids in itsamino acid sequence substituted, deleted and/or added, or a sugar chainmay be similarly substituted, deleted and/or added, provided it hassubstantially the same action as naturally-occurring HGF.

An HGF gradual release gelatin hydrogel preparation in the presentinvention refers to a preparation that is obtained by immersing HGF intothe aforementioned acidic gelatin hydrogel. Although HGF forms a complexwith acidic gelatin hydrogel because it is a basic protein, whenconsidering the absorption inhibitory effects of HGF with respect to theaforementioned changes in ionic strength in solution, this HGF gelatin(hydrogel) complex not only involves electrostatic interaction, but isalso affected by other interactions such as hydrophobic bonding. Thedissociation constant (Kd) of this complex as well as the binding molarratio of HGF to gelatin were obtained according to a Scatchard bindingmodel (Scatchard, G., 1949). The binding molar ratio of HGF to gelatinis such that roughly 7 HGF molecules bind to 1 acidic gelatin molecule.

In addition, the Kd value of acidic gelatin at 37° C. is 5.5×10⁻⁷ M,which is about two to three orders larger than the Kd value of heparinsulfate at 20° C. of 1×10⁻⁹ to 2.0×10⁻¹⁰ M (Rahmoune, H. et al., 1988).This indicates that binding of the HGF gelatin complex is weak and notas strong as that between HGF and heparin sulfate.

In the case the molar ratio of HGF to gelatin is about 1:7 or more,liberation of HGF occurs easily and the resulting behavior is quitesimilar to that of free HGF in terms of activity. However, in the casethe molar ratio of HGF to gelatin is lowered to about 1:7 or less, sincethe HGF is adsorbed and the amount that is liberated is reduced, theapparent activity of HGF appears to decrease.

Thus, although a complex of HGF and gelatin or gelatin hydrogel can bemade in which the molar ratio between the HGF and gelatin is changed invarious ways, in order to avoid an initial burst, a preferable exampleof a complex has a molar ratio in which there are about 7 moles or lessof HGF to 1 mole of gelatin hydrogel.

Furthermore, the weight ratio of HGF to gelatin is preferably amount 5or less, and the weight ratio of HGF to gelatin is more preferably about5 to about 1/10⁴.

Since an HGF gradual release gelatin hydrogel preparation of the presentinvention has HGF gradual release effects and HGF stabilizing effects,it is able to demonstrate the function of HGF for a long period of timeeven in small amounts. Consequently, the inherent function of HGF in theform of cardiovascular protective action such as promotion ofvascularization, prevention of reperfusion injury and inhibition offibrosis are demonstrated, thereby enabling it to be effectively used asa cardiomyopathy therapeutic agent.

An HGF gelatin hydrogel preparation of the present invention can be usedparenterally as an injection preparation. It can be administered, forexample, subcutaneously, intramuscularly, intravenously, intracelomicly,into connective tissue, intraperiosteally or into a damaged organ.

An HGF gradual release gelatin hydrogel preparation of the presentinvention or complex thereof can be used in a suitable drug formaccording to the respective application. For example, it can beadministered in a drug form such as a sheet, stick, particles, rods orpaste. Examples of administration methods include intracutaneous,subcutaneous, intramuscular, intracelomic, into connective tissue andintraperiosteal administration.

Although the dosage of HGF in a preparation of the present invention canbe suitably adjusted according to the patient's severity, patient's ageand body weight, etc., the normal adult dosage is selected from therange of about 0.01 to about 5 μg, and preferably from the range ofabout 0.01 to about 0.5 μg, and can be injected into the affected areaof a peripheral site thereof. In addition, said administration can beperformed a plurality of times in the case effects are inadequate with asingle administration.

As previously described, the applicable disease of an HGF gradualrelease gelatin hydrogel preparation of the present invention iscardiomyopathy. Cardiomyopathy as referred to in the present inventionrefers to all diseases for which lesions are observed in heart musclethat are characterized by the absence of a well-defined cause andabnormal hypertrophy, degeneration or fibrosis of heart muscle.

Specific examples of applicable diseases include dilated cardiomyopathyor hypertrophic cardiomyopathy, idiopathic cardiomyopathy, primarycardiomyopathy and secondary cardiomyopathy, while dilatedcardiomyopathy is preferable. With respect to secondary cardiomyopathy,secondary cardiomyopathy accompanied by adverse drug side effects, toxinaction or viral or bacterial infection is preferable.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a graph showing changes in left ventricular telediastolicdiameter. In contrast to coronary dilation being not only inhibited, butconversely reduced in an HGF treatment group, coronary dilation wasobserved in a sham group.

FIG. 2 is a graph showing changes in left ventricular telesystolicdiameter. In contrast to coronary dilation being not only inhibited, butconversely reduced in an HGF treatment group, coronary dilation wasobserved in a sham group.

FIG. 3 is a graph showing changes in left ventricular minor axisshortening rate (rate of shortening of the left ventricular diameterthat occurs accompanying contraction in a circular cross-section of theheart). In contrast to improvement of coronary systole being observed inan HGF treatment group, exacerbation of coronary function progressed ina sham group.

FIG. 4 is a graph showing changes in the rate of change of leftventricular lumen surface area (rate of reduction of left ventricularcross-sectional area that occurs accompanying contraction in a circularcross-section of the heart). In contrast to improvement of coronarysystole being observed in an HGF treatment group, exacerbation ofcoronary function progressed in a sham group.

EXAMPLES

Experimental Method

An HGF gradual release agent was prepared according to the method ofTabata et al. so that the gradual release of HGF continued for about 4hours after administration. A dilated cardiomyopathy model was preparedby inducing acute myocarditis by subcutaneously administering myosinderived from porcine heart muscle to Lewis rats (males, n =9, purchasedfrom Shimizu Laboratory Animals) followed by allowing six weeks toelapse to induce cardiomyopathy. These animals were divided into an HGFtreatment group (n =4) and a sham group (n=5). A gelatin sheet immersedwith HGF gradual release agent was affixed to the left ventricularanterior wall of the animals of the HGF treatment group followingthoracotomy to promote subsequent gradual release of HGF, while agelatin sheet immersed with saline was adhered to the left ventricularanterior wall of the animals of the sham group. The size and function ofthe heart were followed up for 4 weeks after surgery by echocardiographyusing an ultrasonic probe at a frequency of 10 to 12 MHz.

Experimental Results

In contrast to coronary dilation being not only inhibited, butconversely reduced in the HGF treatment group, coronary dilation wasobserved in the sham group.

Left ventricular telediastolic diameter (cm): Preoperative After 2 weeksAfter 4 weeks HGF group 0.91 ± 0.04 0.86 ± 0.05 0.80 ± 0.05  Sham group0.89 ± 0.03 0.88 ± 0.03 0.91 ± 0.05**p = 0.0043

Left ventricular telesystolic diameter (cm): Preoperative After 2 weeksAfter 4 weeks HGF group 0.67 ± 0.02 0.55 ± 0.08 0.47 ± 0.07  Sham group0.68 ± 0.01 0.63 ± 0.06 0.74 ± 0.05**p = 0.0011

In addition, in contrast to improvement of coronary systole beingobserved in the HGF treatment group, exacerbation of coronary functionprogressed in the sham group.

Left ventricular minor axis shortening rate (%) Preoperative After 2weeks After 4 weeks HGF group 26.7 ± 1.9 37.9 ± 3.4 41.7 ± 9.3  Shamgroup 24.3 ± 2.2 21.1 ± 8.7 17.0 ± 2.8**p = 0.0014

Left ventricular lumen surface area change rate (%) Preoperative After 2weeks After 4 weeks HGF group 40.8 ± 5.2 48.7 ± 11.2 61.8 ± 14.9 Shamgroup 43.1 ± 3.9 35.0 ± 8.0  30.3 ± 3.3**p = 0.0010

Direct administration of HGF gradual release agent to heart muscleresulted in a remarkable improvement of coronary contraction andcoronary systole for 4 weeks after surgery. This technique was suggestedto not only inhibit progression of dilation cardiomyopathy, but alsodemonstrate aggressive therapeutic effects.

1. A cardiomyopathy therapeutic agent that contains hepatocyte growthfactor (HGF) and gelatin hydrogel, and gradually releases HGF.
 2. Acardiomyopathy therapeutic agent according to claim 1 wherein thegelatin has the following physical properties: (1) an acidic gelatinobtained from collagen by alkaline hydrolysis treatment; (2) molecularweight under non-reducing conditions of SDS-PAGE of about 100,000 toabout 200,000 daltons; and; (3) zeta potential in aqueous solution ofabout −15 to about −020 mV.
 3. A cardiomyopathy therapeutic agentaccording to claim 1 wherein cardiomyopathy is dilation cardiomyopathy.4. A cardiomyopathy therapeutic agent according to claim 1 wherein thecardiomyopathy is hypertrophic cardiomyopathy.
 5. A cardiomyopathytherapeutic agent according to claim 3 wherein the cardiomyopathy isidiopathic cardiomyopathy, primary cardiomyopathy or secondarycardiomyopathy.
 6. A cardiomyopathy therapeutic agent according to claim2 wherein cardiomyopathy is dilation cardiomyopathy.
 7. A cardiomyopathytherapeutic agent according to claim 2 wherein the cardiomyopathy ishypertrophic cardiomyopathy.
 8. A cardiomyopathy therapeutic agentaccording to claim 6 wherein the cardiomyopathy is idiopathiccardiomyopathy, primary cardiomyopathy or secondary cardiomyopathy.
 9. Acardiomyopathy therapeutic agent according to claim 4 wherein thecardiomyopathy is idiopathic cardiomyopathy, primary cardiomyopathy orsecondary omyopathy.
 10. A cardiomyopathy therapeutic agent according toclaim 7 wherein the cardiomyopathy is idiopathic cardiomyopathy, primarycardiomyopathy or secondary cardiomyopathy.